Saturday, October 27, 2007

The negative consequences of alcohol use and abuse have a disproportionate impact on racial and ethnic minorities in the United States. New research findings indicate that racial disparities in treatment completion could be reduced by increasing enrollment in residential alcohol treatment for African American and Hispanic alcohol abusers.

Results are published in the November issue of Alcoholism: Clinical & Experimental Research.

“Both the National Longitudinal Alcohol Epidemiologic Survey from 1991-1992, and the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions found that African Americans have similar or lower rates of heavy drinking, binge drinking, and alcohol dependence as White Americans,” said Ricky N. Bluthenthal, senior scientist at the RAND Corporation and corresponding author for the study.

Yet despite these similarities in alcohol consumption, observed Laura A. Schmidt, associate professor of health policy in the School of Medicine at the University of California, San Francisco, minorities experience more adverse health and social consequences as a result of their drinking.

“For example, as a white woman, I might drink three drinks per day, which might increase my risk of dying from cirrhosis by 50 percent,” she explained. “A black or Hispanic woman with the same age or health status who drinks the same amount as me might have a 75 percent increased risk of dying from cirrhosis. We think that this disproportionate disease burden has something to do with other factors that ‘go with’ race/ethnicity, such as poorer nutrition. This means that a minority person can do everything possible to avoid alcohol-related problems – cirrhosis, criminal victimization, traffic fatalities, etc. – and still have a higher risk of these problems compared to whites.”

For this study, researchers analyzed the discharge records of 10,591 alcohol-treatment patients who attended publicly funded treatment facilities in Los Angeles County during 1998 to 2000 in order to calculate completion rates. The sample comprised 4,141 African American, 3,120 Hispanic, and 3,330 white patients; furthermore, 5,795 were in outpatient and 4,796 were in residential treatment.

“This is one of the first studies to find consistently lower alcohol-treatment completion rates for African American patients as compared to White patients in a large publicly funded alcohol-treatment system,” said Bluthenthal. “This occurred regardless of treatment setting, that is, outpatient or residential treatment.”

Furthermore, African American patients appeared less likely to be enrolled in residential alcohol treatment despite having more severe alcohol abuse characteristics on average.

“We calculated that if African American patients were assigned to residential treatment at the same rate as White patients,” said Bluthenthal, “the racial disparity in alcohol-treatment completion might decline by as much as 20 percent between African Americans and Whites.” He added that this would also apply to Hispanics, although findings indicated a smaller racial disparity in alcohol-treatment completion between Hispanic and white patients.

“Because it is so much harder for a minority person to get into treatment, only the most persistent, motivated people are likely to get into care,” said Schmidt. “Thus, we would expect that minorities in treatment have higher completion rates and greater success in treatment than comparable minorities. What Dr. Bluthenthal and colleagues are showing is that, despite all this, minorities are less likely than whites to stay in treatment, other factors being equal. Thus, there are multiple racial/ethnic disparities in play here: minorities have a disproportionate risk of alcohol-related harm, they are less likely to get treatment, and when they do get treatment, they are less likely to stay in it and complete the program.”

Bluthenthal suggested that one way to increase access to residential treatment for African American alcohol abusers might be to more consistently assign alcohol-treatment patients with higher alcohol-abuse severity to residential treatment programs, which generally provide more intense services and have higher completion rates, as compared to outpatient treatment programs.

Schmidt agreed. “This is one of several policies that need to be put in place to reduce racial/ethnic disparities in alcohol treatment,” she said. “There are numerous disparities and therefore, more than one policy solution is required. My research shows that the most severely affected minorities are the least likely to receive treatment. When they do get treatment, it is in less intensive settings, and now we see from this report, for a shorter duration of time. Despite all this, minorities who drink at the same levels as whites will experience higher rates of alcohol-related harm. Therefore, the need for treatment is greater in minority communities and yet the care is diminished on multiple levels. It is important to underscore that heavy drinking is not just a problem on its own, but is also a risk factor for a whole host of conditions, including coronary heart disease, stroke, cancers, and trauma.”

Schmidt said that another concern is the growing use of outpatient alcohol treatment in the US. “The trend towards outpatient care began in the early 1990s,” she said. “Currently, about 60 percent of the care for alcohol problems provided in the US is in outpatient settings and this figure will likely grow in the years to come. Based on what this ACER paper reports, we can expect to see a widening gap in completion rates between minorities and whites as more and more care is delivered in outpatient settings.”